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"The Euthanasia Debate: Assessing the Options." Part Two in a
Two-Part Series on Euthanasia (an article from the Christian
Research Journal, Spring 1992, page 14) by J. P. Moreland.
The Editor-in-Chief of the Christian Research Journal is
Elliot Miller.
-------------
In Part One of this series I examined two central aspects of
the euthanasia debate. First, several important background concepts
in ethical theory were explained. Second, the main features of the
libertarian and traditional views of euthanasia were set forth.
The libertarian view, advocated by philosopher James Rachels,
states that there is no morally relevant difference between active
and passive euthanasia. Moreover, Rachels says, it is
_biographical_ life (which includes a person's aspirations, human
relationships, and interests), not _biological_ life (being a human
being), that is important from a moral point of view (_see_ Part
One, p. 13). And if passive euthanasia is morally justifiable in a
given case, then so is active euthanasia, since there is no
relevant distinction between them.
The traditional view affirms that there is a clear, moral
difference between active and passive euthanasia. The former
involves the intentional, direct taking of an innocent human's
life. The latter involves foregoing treatment (through either
withholding or withdrawing treatment) and allowing the natural
dying process to run its course. According to the traditional view,
active euthanasia is morally forbidden, but passive euthanasia is
morally permissible _if certain conditions are present:_ the
patient is terminal, death is imminent, treatment is judged
extraordinary, and death is not directly intended or caused, but
merely foreseen.
At this point we are prepared to assess the options. In what
follows, I will (1) critique the libertarian view, (2) defend the
traditional view, (3) address the issue of foregoing artificial
food and water, and (4) place the euthanasia debate in the larger
context of broad, world view issues.
A CRITIQUE OF THE LIBERTARIAN VIEW
*Arguments for the View*
There are five primary arguments for the libertarian view.[1]
The first two are related to the biological/biographical and the
active/passive distinctions discussed above.
*Argument 1: The Argument from Autonomy.* Since biological life
(being a human being) is not the real, moral issue, then life is
not intrinsically valuable or sacred _simply because_ it is human
life. The important thing is that one has _biographical_ life --
and this involves a person's ability to state, formulate, and
pursue autonomously chosen interests, desires, and so forth. If a
person autonomously chooses to end his or her life or have someone
else assist him or her in doing so, then it is morally permissible.
One should be free to do as one chooses as long as no harm is done
to others.
*Argument 2: The Equivalence Argument.* There is no morally
relevant distinction, the libertarian view says, between active and
passive euthanasia. Passive euthanasia is sometimes morally
permissible. Thus, active euthanasia is sometimes morally
permissible. The Smith and Jones cases, described in Part One of
this article, were presented by Rachels as an illustration of his
view that active and passive euthanasia are morally equivalent.
*Argument 3: The Argument from Mercy.* It is cruel and
inhumane, it is said, to refuse the plea of a terminally ill person
that his or her life be ended to avoid unnecessary suffering and
pain. Allowing such a person to terminate his or her life is an act
of mercy.
*Argument 4: The Best Interests Argument.* If an action
promotes the best interests of everyone concerned and violates no
one's rights, the libertarian view maintains, then that action is
morally acceptable. In some cases, active euthanasia promotes the
best interests of everyone concerned and violates no one's rights.
Therefore, in those cases active euthanasia is morally acceptable.
*Argument 5: The Golden Rule Argument.* Moral principles, it is
argued, ought to be _universalizable._ In other words, if I don't
want someone to apply a rule to me, I shouldn't apply it to others.
Similarly, if I want someone to apply a rule to me, I ought to be
willing to apply it to others. Now, suppose I were given a choice
between two ways to die. First, I could die quietly and without
pain, at the age of eighty, from a fatal injection. Or, second, I
could choose to die at eighty-plus-a-few-days of an affliction so
painful that for those few days before death I would be reduced to
howling like a dog, with my family standing helplessly by. The
former death involves active euthanasia, and if _I_ would choose it
under such circumstances, I should be willing to permit _others_ to
choose it too.
*Criticisms of the View*
Since the first two arguments above are so central to the
libertarian viewpoint, they require special treatment. Before we
consider these, let us briefly examine arguments three, four, and
five.
*The Argument from Mercy*
Critics of the libertarian view have responded to the argument
from mercy in at least four ways. First, there are very few cases
where modern medicine cannot alleviate suffering and pain. It is
wrong ethical methodology to build an ethical doctrine on a few
problem cases. Libertarian advocates violate this principle by
placing too much weight on an argument that applies only to a small
number of situations.
Second, though this can be abused, value can be found in
suffering. One can grow through it; one can teach others how a
wise, virtuous person handles life's adversities -- including
physical suffering and death; one can show that one cares for his
or her membership in community with others and that it is not right
to abandon being present to one another in time of need (e.g., a
conscious, dying patient can signal his or her commitment to
community by not giving up on life; the community in turn can
continue to value and care for the dying patient); and one can
affirm the fact that people have value and purpose beyond
happiness, the absence of pain, or the ability to pursue
autonomously chosen goals.[2]
Third, even in cases where death is imminent and pain cannot be
minimized or eliminated through normally accepted dosages of
medication, active euthanasia is not the only option. A doctor
_can_ give the necessary pain medication if the intent is solely to
alleviate pain and not to kill, even if it can be foreseen that
such an action will hasten death. In this case death is a foreseen,
tolerated, but _unintended_ effect.
Finally, critics of the argument from mercy who are theists
point out that life is a gift from God and that we are not the
sole, absolute owners of our lives. Thus, active euthanasia is an
act of rejecting life as a gift from God and it fails to trust the
providential care of God and the possibility of good that can
result from suffering (_see_ point number two above). The strength
of this argument depends on whether one accepts theism and on the
version of theism one adopts. For example, views of God which
picture Him as removed and uncaring will not be relevant here, but
the existence of the biblical God is very relevant to this
argument.
*The Golden Rule Argument and the Argument from Best Interests*
Two responses have been offered that apply equally to the
Golden Rule argument and the best interests argument. First, both
arguments beg the question against a sanctity of life view in favor
of a quality of life view. If (in theological language) life is
sacred because humans are made in the image of God, or if (in
philosophical language) persons have intrinsic value simply by
being human and thus are ends in themselves, then active euthanasia
inappropriately treats a person as a means to an end: a painless
state of death. Even if we grant that a painless state is a good
end, it is immoral to accomplish even a good end by an evil means.
Intentionally taking the life of an innocent human being is wrong,
regardless of the end it accomplishes. Such an act is dehumanizing
because it treats a human being (which has intrinsic value and is
an end in itself) as a mere thing (which merely has instrumental
value and is a means to an end).
Not everything people take to be in their own best interest is
morally acceptable. Similarly, not everything people would wish to
have done to them is morally appropriate. Quality of life judgments
are often subjective and thus can be morally defective. Put
differently, people can dehumanize themselves -- and actually do so
in active euthanasia by intentionally killing themselves (or by
others intentionally killing them). The strength of this argument
hinges on the debate about the relative importance of biological
and biographical life (more will be said about that debate below).
Second, it may not be in my own best interests or in the best
interests of others for me to die. If I am willing to allow others
to perform active euthanasia on me (and, by the Golden Rule
argument, I'm willing to do so to them), I am mistaken in my
perspective and leaving out morally relevant information.
For example, I may miss the opportunity to learn things through
suffering. Even if a person is not conscious, he or she can
contribute to the community an example of courage in the face of
adversity. This could happen in at least two ways. First, a person
could leave an advanced directive prior to reaching a state of
unconsciousness. Such a directive could express the fact that no
heroic means need to be administered if the person becomes terminal
and death is imminent, but that the person wishes to be kept alive
if he or she is not terminal as an expression to the community of
the intrinsic value of human existence. Second, the family and the
rest of the community is given a chance to show courage in the face
of adversity by sacrificially caring for someone when nothing can
be given back in return. These lessons are extremely important,
given our current narcissistic culture with its emphasis on
personal peace and comfort. Therefore, the chance to teach these
lessons and exemplify these values should be factored into our
thinking about how we should approach the subject of our own
deaths. Hence when one engages in active euthanasia, one abdicates
one's privilege and responsibility to live out one's life in
community with others (and, theists would add, with God).
*Problems with the Biological/Biographical View of Life*
As noted earlier, a central feature of Rachels's argument from
autonomy is the distinction between the biological and biographical
views of life. Here I will address three critical problems with
this distinction.
(1) Rachels's understanding of biographical life, far from
rendering biological life morally insignificant, _presupposes_ the
importance of biological human life. His libertarian view describes
biographical life as a unity of capacities, interests, and so forth
that a person freely chooses, and that unites the various stages of
his or her life. Now it is precisely these (and other) features of
life that philosophers try to capture in the notion of an _essence_
or _natural kind_ (e.g., humanness). It is because an entity has an
essence and falls within a natural kind that it can possess a unity
of dispositions, capacities, parts, and properties at a given time
and can maintain identity through the various stages of its
biographical life. And it is the natural kind that determines what
sorts of activities are appropriate and natural for that entity.
Thus, falling under a natural kind -- being a _human being_ in
this case -- is a necessary condition for (1) having a biographical
life in the first place, and (2) having the possibility of a _sort_
of life appropriate for the kind of organism a thing is. (For
example, Smith ought to learn math and ought not to learn to bark
because Smith is a human and not a dog.) Now, the idea of the
natural kind "human being" is not to be understood as a mere
biological concept. Rather, it is a _metaphysical_ concept that
grounds both biological functions and moral intuitions.
In sum, if we ask why biographical life is both possible and
morally important, the answer will be that such a life is grounded
in the kind of entity -- a human being in this case -- that
typically can have that life. And the natural kind "human being" is
not merely a biological notion, but a metaphysical notion that
includes moral properties. Human beings have both biological _and_
moral properties and thus are objects of intrinsic value simply as
humans.
(2) Rachels's libertarian view seems to collapse into
subjectivism. According to him the importance of a biographical
life is that a person has the capacity to set and achieve goals,
plans, and interests that are important from the point of view of
the individual him/herself. But if this is true, then there is no
objective moral difference in the different goals one chooses. One
can only be right or wrong about the best means to accomplish these
goals.[3]
To better grasp this, consider Rachels's treatment of the 1973
"Texas burn case" where a man known as Donald C. was horribly
burned but was kept alive for two years in the hospital against his
will, and is still alive today. Rachels believes this man's desire
to die was rational because he had lost his biographical life. Says
Rachels:
Now what could be said in defense of the judgment that
this man's desire to die was rational? I believe focusing
on the notion of his _life_ (in the biographical sense)
points us in the right direction. He was, among other
things, a rodeo performer, a pilot, and what used to be
called a "ladies' man." His life was not the life of a
scholar or a solitary dreamer. What his injury had done,
from his point of view, was to destroy his ability to
lead the life that made him the distinctive individual
that he was. There could be no more rodeos, no more
aeroplanes, no more dancing with the ladies, and a lot
more. Donald's position was that if he could not lead
_that_ life, he didn't want to live.[4]
But surely some rational life plans are more objectively
valuable than others. If a woman has a life plan to be the best
prostitute in America, but has an accident that confines her to a
wheelchair such that she is in no pain, can lead a relatively
productive life in various ways, but can no longer pursue her
desire to be the best prostitute, that person could want to commit
suicide. Does it make sense to say that she would be rational to
desire to die? Does it make sense to say that her biographical life
is what gave her life value?
Rachels's view would seem to imply an affirmative answer to
both of these questions. Contrary to Rachels, however, it is clear
that this woman was dehumanizing herself. And it is a moral strike
against her community that they allowed her to reach the point of
formulating such a biographical life plan in the first place. The
simple fact is that people can dehumanize themselves by choosing
biographical life plans that are morally wrong, and Rachels's view
cannot account for this fact.
Some manners of life are morally appropriate for humans and
others are not. The difference seems to be grounded in the fact
that a human being is a creature of value, and a choice of life
plans can be devaluing to the sort of creature one is. Without
objective content which sets limits for what counts as a morally
appropriate approach to living versus approaches that are trivial,
immoral, or dehumanizing, subjectivism would seem to follow. For
Rachels, _any_ life plan is acceptable for me as long as I have
freely chosen it and it doesn't harm others. But a person can be
wrong about his or her point of view.
Rachels denies that his view is equivalent to moral
subjectivism. He argues that it is objectively true that something
has value for someone if its loss would harm that person. But this
is a mere formal principle. At best, it only gives us a necessary
condition for a moral principle. But moral principles must have
enough content to serve as action guides (principles with enough
teeth to tell us what to do and not do). Action guides need
material content, and, in Rachels's view, the material content one
gives it -- that is, what it means to be harmed -- will depend in
large degree on what _interests_ constitute one's biographical life
(the case of Donald C. illustrates this). But since a choice of
interests is subjective in Rachels's view, his denial of
subjectivism fails to be convincing.
(3) According to Rachels, the rule not to kill is no longer
morally relevant to people without biographical lives. This is
because the point of the rule is to protect people with
biographical lives. It would seem, then, that a person who no
longer has such a life -- who has no point of view -- is no longer
included in our duty not to kill. But if the person has lost the
right not to be killed, it would seem that _other_ rights would be
lost as well, since the right to life is basic to other rights. In
this case, it would be morally permissible to experiment on such a
person or kill him or her brutally. Why? Because we are no longer
dealing with an object that has the relevant rights.
Rachels could respond that some other factor is relevant that
would forbid killing the patient violently. Perhaps others would
see the act; perhaps such an act would weaken respect for life; or
perhaps the act would bring out hostility in the doctor's
character. The difficulty with this response should be obvious.
Cases can be set up where these factors do not obtain: No one knows
about the brutal killing of the patient; the doctor's psychologist
has told him to express his aggression toward objects that remind
him of his mother; and so forth. In these cases there would seem to
be no moral difference between a lethal injection or a more brutal
means of killing. The patient -- who has no life and is not an
object of moral consideration -- approaches thing-like status. If
Rachels's libertarian views do, in fact, entail this conclusion,
and if this conclusion is as morally unacceptable as it would seem
to be, then Rachels's views must be mistaken.
*The Killing/Letting Die Distinction*
The "bare difference" argument involving the Smith and Jones
cases (_see_ Part One) was an attempt to show that two different
actions -- one killing and one letting die -- can have the same
intentions and results, and thus are both morally forbidden despite
the difference in actions. In fact, the cases are _supposed_ to
show (as presented by Rachels) that the difference between killing
and letting die is irrelevant. But the cases fail to make the
point.
First, they have what some philosophers call a masking or
sledgehammer effect. The fact that the taste of two wines cannot be
distinguished when both are mixed with green persimmon juice fails
to show that there is no difference between the wines. The taste of
the persimmon juice is so strong that it overshadows the
difference. Similarly, the intentions and motives of Smith and
Jones are so atrocious, and both acts are so clearly unjustified,
that it is not surprising that other factors of their situation
(_doing_ something versus _refraining_ from doing something) are
not perceived as the morally determinative factors in the cases.
Second, the main difficulty with the bare difference argument
lies in its inadequate analysis of a human moral act. Thomas
Sullivan put his finger on the problem when he argued that Rachels
makes the distinction between the act of killing and the act of
letting die be "a distinction that puts a moral premium on overt
behavior -- moving or not moving one's parts -- while totally
ignoring the intentions of the agent."[5]
In our discussion of the principle of double effect (_see_ Part
One), we saw that moral acts are not defined merely in terms of the
movements of body parts taken to secure an end. Rather, a moral act
is a whole with a _motive, intent,_ and _means-to-an-end_ as parts
of the act. Only the latter involves overt body movement and it is
really the component of intent that defines the essence of a moral
act.
The importance of intent can be seen as follows. Suppose a mad
scientist places a remote control device in a person's brain that
programs the person to hit the first person he sees after the
operation. After the patient wakes up someone comes in to see him
and is hit on the nose. Contrast this with a second person who
strikes someone on the nose because of hatred and jealousy. Both
acts involve the same set of physical occurrences or means-to-ends
(moving body parts to strike someone). But the first person's
behavior was causally determined by an implanted device and he
acted out of no intent at all. The second person acted out of a
clear intent to harm. The second act is immoral in a way the first
one is not and the difference lies in the presence or lack of a
morally relevant intention.
Rachels's bare-difference cases differ in means-to-ends, but
they have the same intent. Contrary to Rachels, defenders of the
active/passive distinction do not ground the difference on mere
physical occurrences or means-to-ends. The acts of Smith and Jones
drowning the two children differ _only_ in physical movements. But,
as we have seen, that is just part of a human act, not the whole.
Rachels leaves out the _intent_ of the two acts in his analysis. A
defender of the traditional view would not allow such an analysis
to stand.
Rachels sets up a different case to try to show that two acts
can be the same with different intentions and, thus, intentions are
not a part of an act.[6] Jack visits his sick and lonely
grandmother, and his only intention is to cheer her up. Jill also
visits the grandmother and provides an afternoon of cheer. But Jill
does it to influence the grandmother to include Jill in her will.
Both of them did the same thing: they spent an afternoon cheering
up the grandmother. Jill should be judged harshly and Jack praised,
not because they did different _acts,_ but because Jack's character
is good and Jill's faulty.
But if the traditional analysis of human action is correct,
then Jack and Jill did not do the same actions. Their actions may
be identical at the level of means-to-ends, but their intents were
different. Jack's action was one of loving his grandmother and
cheering her up by being with her. Jill's action was one of
securing a place in the will by being with her.
In view of these factors, it is clear that the libertarian view
of active euthanasia, expressed by perhaps its most articulate
exponent, is inadequate.[7] Most philosophers agree with this
assessment and hold to the traditional view of euthanasia. Some of
their reasons will become clearer as I elaborate on this view.
*A DEFENSE OF THE TRADITIONAL VIEW*
At least five arguments have been offered in support of the
traditional view of euthanasia. Let us now briefly examine all
five.
*Argument 1:* Active euthanasia violates a person's negative
right to be protected from harm (death), while passive euthanasia
only violates a person's positive right to have a benefit
(continued treatment). The former usually has a higher degree of
incumbency than the latter, especially when the negative right
being violated involves death itself.
Two responses have been offered to this argument. First, some
deny the distinction between active and passive euthanasia. (We
have already looked at this and found reasons to uphold the
distinction.) Second, it has been pointed out that the difference
between positive and negative rights is too small to justify a
denial of the former and an acceptance of the latter. It does seem
that judgments about the relative importance of negative and
positive rights can be somewhat subjective, so -- taken by itself
-- argument one is a weak one.
*Argument 2:* A mistaken diagnosis can be reversed in passive
euthanasia (the person can get well if the disease is not as
serious as was thought), but no such possibility exists in active
euthanasia. The basic response to this argument is that there are
a small number of cases where there is a serious possibility of a
mistaken diagnosis, and only in those cases should active
euthanasia be forbidden. When the diagnosis is clear, active
euthanasia is permissible. This response seems to shift the moral
debate about euthanasia to other issues. For example, is active
euthanasia ever permissible, mistaken diagnosis or not? Thus,
argument two is best understood as a warning against active
euthanasia and a principle that severely limits its applicability.
*Argument 3:* Active euthanasia violates the special duty that
physicians have to patients, namely, the preservation of their
lives. Rachels counters this by arguing that if active euthanasia
is justified, then the medical profession is built around the wrong
set of duties. So we need to come up with a more adequate
definition for medicine that allows for the practice of active
euthanasia. For the sake of argument, says Rachels, let's call this
newly defined practice "smedicine." The only difference between
"smedicine" and "medicine" is that the former allows and the latter
forbids active euthanasia. Rachels's question, then, is this: Why
should we prefer "medicine" over "smedicine"? In his view, we
should not.
Two points can be offered by way of rejoinder. First, the
medical profession did not materialize out of thin air. Rather, it
represents the accumulated wisdom and virtue of several
generations. Thus, the burden of proof is surely on anyone who
would recommend a change in one of its foundational values. Second,
certain values seem to be necessary as presuppositions before we
can make sense out of medicine itself, and these values run counter
to the practice of "smedicine": the intrinsic value of each human
being beyond mere autonomy, the need to be a caring presence to one
another in difficult times, and the need to use suffering and death
as opportunities to teach lessons about life. Thus, smedicine is
not a minor adjustment in medicine, but a radical alternative that
should be rejected.
*Argument 4:* Active euthanasia weakens respect for human life;
thus, even if it could be justified in a particular case, we could
not adopt active euthanasia as a general policy. This is a slippery
slope argument that can take two forms. A _logical_ slippery slope
argument says that if a disputed act A cannot be logically
distinguished from an act B in a morally relevant way, and we know
that B is wrong, then A is wrong too. A _causal_ slippery slope
argument says that even though a disputed act A is really different
from a forbidden act B, nevertheless, if we allow A it will
contribute to causing people to do B, and so A should not be
allowed. Argument four is a causal slippery slope argument. Its
force needs to be settled by factual, sociological data because it
is an empirical question: What impact on society will a certain
practice have?
*Argument 5:* The intentional killing of an innocent human life
is wrong because human life is sacred. Because human beings are
made in the image of God, they have intrinsic value as ends in
themselves by virtue of their membership in the natural kind "human
being." Active euthanasia violates this fundamental principle. This
is the cornerstone of the traditional view. Advocates of the
libertarian view, however, reject this principle and put a premium
on biographical life, individual liberty, private rights, and
autonomy.
FOREGOING ARTIFICIAL AIR, NUTRITION, AND HYDRATION
At this point in our discussion, a word needs to be said about
the current debate regarding the moral appropriateness of foregoing
artificial air, nutrition (food), and hydration (water). Because
most of the current discussion is centered on food and water, we
will focus on these. But what is said about them could be equally
applied to air.[8]
Some believe that food and water should be viewed as any other
treatment, and cases where passive euthanasia would be justified in
general -- cases, for example, in which it would be appropriate to
stop renal dialysis -- are cases where foregoing artificial
nutrition and hydration would be justified. On the other hand,
there are those who argue that artificial food and water should not
be foregone (except in very rare cases stated below) in cases like
those listed above. Three reasons are offered for this.
First, ethically speaking, artificial food and water are in a
category different from life-sustaining medical treatments. The
latter clearly function to treat some specific disease or to assist
some diseased bodily function. But food and water do not have as
their direct or immediate intention the cure of any pathological
condition whatsoever. They are not therapeutic _treatments_ at all,
much less extraordinary ones. Rather, food and water are means used
to meet basic human needs for life and to provide comfort.
Life-sustaining interventions can be foregone on the grounds that
they are extraordinary treatments, but food and water (and air) are
almost never either extraordinary or treatments, so their
withdrawal cannot be justified in this way.
Second, when an extraordinary treatment is foregone, then death
may result. But such a death need not be directly intended as a
final end for the person or as an immediately caused means to some
end (e.g., a painless state that death brings). It is the disease
itself that actually causes death directly. However, if food and
water are withdrawn or withheld, then death is intentionally
brought about directly and immediately by that act itself. In such
a case, disease does not directly kill; the act of foregoing
treatment directly kills. Thus, a decision to forego artificial
food and water is a decision to commit active euthanasia.
It might be helpful to compare food and water (which are almost
never means of treatment) with air administered by a mechanical
respirator (which _is_ a means of treatment). Artificial food and
water are different from, say, a mechanical respirator. Respirators
_assist_ the breathing functions of the body, but artificial
nutrition and hydration _replace_ the natural bodily functions.
Thus, when a respirator is withdrawn, a person usually goes on
breathing. If the person does die, the removal of the respirator
does not _directly cause_ death but merely permits an existing
pathology to run its natural course. Furthermore, a respirator can
be an _extraordinary_ artificial means of treatment and its removal
can be morally justified on this grounds: a respirator can be
foregone when a patient is terminal and death is imminent because
(1) death is not intended or directly caused, and (2) it can be an
extraordinary artificial treatment.
When food and water are withdrawn, however, this act itself
brings about a new and lethal situation for the person, namely, a
starvation or dehydration situation. The removal of food and water
is morally identical to denying a patient air by placing a plastic
bag over his or her head because they both directly and
intentionally bring about death in a very short time and they deny
the patient ordinary, natural resources needed to sustain life.
Thus, food, water, and air should not be foregone when such an act
intentionally or directly causes death and when it denies the
patient a natural resource for life.
There is another reason that food and water are morally
different from an extraordinary life-sustaining treatment. If we
forego an extraordinary life-sustaining treatment, we are focusing
on the _quality of the treatment itself,_ and our intention is to
spare a person an unduly burdensome means of medical intervention.
On the other hand, if we forego food and water, we are focusing on
the _quality of the patient's life itself,_ not the treatment. We
are not considering ordinary/extraordinary _treatments,_ but
valuable/unvaluable _lives._ In the latter case, we make a judgment
that the life of a person who is in a certain situation is no
longer morally valuable and we violate our duty to respect human
life.
Does this mean that there are no cases where it would be
morally permissible to forego food and water? No, it does not. The
only ethically justifiable reasons for such an act in this view
would be those that would also justify the removal of air: (1) if
the food and water would not prolong life perceptibly (the person
would die in a short time span whether or not he or she had
nutrition or hydration); (2) death is not intended or directly
caused (e.g., nutrition and hydration are judged extraordinary
treatments given to a dying patient); and (3) the means of
administering the food and water to a terminal patient is
extraordinary and excessively burdensome. In this latter case, if
the means used to give food and water is, say, excessively painful
or dangerous, then the administration of the means itself places an
undue burden on the terminal patient and can thus be foregone.
These situations are in the minority, but they do arise.
A CHRISTIAN WORLD VIEW OR MINIMALISTIC ETHICS?*
A world view is a person's overall philosophy of life. It
includes a person's beliefs about what is real and true, right and
wrong, rational and irrational.
While there are exceptions to the rule, many moderns advocate
a secular world view that has these features:[9] First, we live in
a pluralistic society and cannot agree about the good life; that
is, about our view of what is important and morally right, what the
purpose of life is, and what types of persons and communities we
should try to become. Thus, the most important function of ethics
and law is to keep us from harming one another. The most important
ethical principle is the principle of autonomy. If a person has
certain wishes regarding his or her life, then those desires should
be honored unless they significantly harm another. We have no moral
right to tell others how to live and die.
Second, I do not exist for morality; rather, morality exists
for me. The whole point of morality is to protect my individual
rights, preserve my individual happiness, and maintain a
well-ordered society within which I can seek happiness in whatever
way I define happiness (provided, of course, that I do not harm
others). The main purpose of life is happiness, and pain and
suffering are to be avoided whenever possible. My own goals and
purposes are what give my life meaning, and when I cannot pursue
those goals and purposes in a way that satisfies me, my life is no
longer meaningful.
Third, secularists say, my loyalty to my community is a much
lower priority than is my loyalty to myself. Communities exist for
the individual, not vice versa. And when community loyalties
require me to sacrifice personal pleasures in a way that is not in
my own self interest, then I have no obligation to the community.
Fourth, the time and manner of my death is basically my own
business and others have little right to intervene when it comes to
my decisions in this area. My life is my own, death is an act that
I must undergo alone, and I have the moral right to end my life in
whatever way I rationally and autonomously choose.
In a number of ways, a Christian world view diametrically
differs from the minimalistic, secular one just presented. First,
there are true moral principles that all men and women ought to
know, and there are duties that we have to live by morally _even
when we don't want to do so._ The principle of autonomy is an
important moral principle, but it is not the _only_ or _most
important_ one in all cases. A person can autonomously choose to
treat him/herself in a trivial and dehumanizing way. If a person
wants to cease an ordinary life-sustaining treatment simply because
he or she can no longer play the piano or do some activity that was
once his or her primary source of satisfaction, then that person
may still be making a moral mistake. Why? Because the person should
never have received his or her whole meaning in life through
engaging in that activity in the first place.
Second, while happiness is important, it is not _the_ point of
life. The main point of life is to glorify, enjoy, and serve the
living God, and a primary feature of a life well lived is morality.
Morality does not merely exist to make me happy. Rather, part of
the very meaning of life is that I should seek to become a virtuous
person who models a morally sensitive life.
Furthermore, while we should not glorify pain and suffering,
they can have meaning. I can grow through them and I can teach
others to value life, as well as give them hope by my example of
appropriately coping with pain and suffering and not giving up on
life. Thus, when I am trying to decide what to do with a painful
situation, my consideration should not only be trying to avoid the
pain. I should also try to consider the opportunity pain gives me
to grow, teach others, trust God, and model a concern for a
virtuous, moral life.
Third, while I am certainly an individual with rights, I am
equally a member of my community, and I have duties and
responsibilities to that community. I must make my individual moral
decisions in light of how they will affect those around me.
Finally, life is not my own to do with as I please. Rather, my
life is a gift from God, and I should face my own death as I
believe He would have me face it. This may be difficult to
determine in some cases, but I should at least raise these
considerations when deliberating about when and how I wish to die.
There is one final point that should be made. The modern
secular world view has abandoned the doctrine of the image of God
in man. Thus, it does not have the resources to ground the dignity
of a human being. Indeed, many secularists claim that the belief
that someone is special just because he or she is human is
_speciesism_ -- an unjustified bias toward one's own species.[10]
In place of the image of God in man, the "value" of life is
justified by the possession of one or more of a number of criteria:
biographical life, rationality, the ability to use language,
possession of a self concept, and so forth. These become criteria
either for personhood or for a meaningful quality of life.
But these surrogates for the image of God in man fail because
they are possessed by different humans in different degrees, and
some higher primates can have them to a greater degree than, say,
a defective newborn or elderly human. Thus, these secular
substitutes have difficulty (1) justifying the view that all humans
have equal rights and dignity; (2) justifying the view that humans
have more value than animals; and (3) avoiding the conclusion that
advanced creatures on another planet or humans developed by genetic
engineering have more value than current humans, and thus,
_anything_ we wish to do to develop better humans (e.g.,
experimenting on present humans) is prima facie justified.
In a very real sense, the euthanasia debate is yet another
crucial battle in an ongoing cultural war of world views. As the
debate accelerates in coming years, it is critical that Christians
be involved, for the stakes are truly high.[11] Indeed, it is
literally a matter of life and death -- for countless individuals
and perhaps for our society as well.
*NOTES*
1 Some of these are listed in James Rachels, _The End of Life_
(Oxford: Oxford University Press, 1986), 151-67. _See_ also,
Sidney H. Wanzer, et. al., "The Physicians Responsibility toward
Hopelessly Ill Patients: A Second Look," _The New England
Journal of Medicine_ 320 (30 March 1989):844-49.
2 Cf. Benedict M. Ashley and Kevin D. O'Rourke, _Health Care
Ethics_ (St. Louis, MO: The Catholic Health Association of the
United States, 1982), 199-205; Stanley Hauerwas, _Suffering
Presence_ (South Bend, IN: University of Notre Dame Press,
1986).
3 Rachels, 46-47.
4 _Ibid.,_ 54.
5 T. D. Sullivan, "Active and Passive Euthanasia: An Important
Distinction," reprinted in _Biomedical Ethics,_ eds. Thomas A.
Mappes and Jane S. Zembaty (New York: McGraw-Hill, 1986), 390.
6 Rachels, 93-94.
7 Cf. J. P. Moreland, "Review of The End of Life," _The Thomist_
53 (October 1989):714-22.
8 A fuller treatment of this debate can be found in Joanne Lynn,
ed., _By No Extraordinary Means_ (Bloomington, IN: Indiana
University Press, 1986).
9 Cf. Daniel Callahan, "Minimalistic Ethics," _Hastings Center
Report_ 11 (October 1981):19-25; Hauerwas; Tim Smick, Jim
Duncan, J. P. Moreland, Jeff Watson, _Eldercare for the
Christian Family_ (Dallas: Word Publishing, 1990).
10 Cf. Helga Kuhse and Peter Singer, _Should the Baby Live?_
(Oxford: Oxford University Press, 1985), chapter 6; J. P.
Moreland and Norman L. Geisler, _The Life and Death Debate_
(Westport, CT: Praeger Books, 1990), chapter 3.
11 For more on the relationship between God, morality, and world
view, _see_ J. P. Moreland, _Scaling the Secular City_ (Grand
Rapids: Baker Book House, 1987), chapter 4; J. P. Moreland and
Kai Nielsen, _Does God Exist? The Great Debate_ (Nashville:
Thomas Nelson Publishers, 1990), part two.
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End of document, CRJ0106A.TXT (original CRI file name),
"The Euthanasia Debate: Assessing the Options."
release A, May 31, 1994
R. Poll, CRI
(A special note of thanks to Bob and Pat Hunter for their help in
the preparation of this ASCII file for BBS circulation.)
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